Hepatitis B Liver Cancer Treatment

Effects Of Hepatitis B Virus And Hepatitis C Virus On Hepatocellular Micrornas

MicroRNAs are small non-coding RNAs that regulate diverse cell functions including cell proliferation, differentiation and apoptosis. Recent reports highlight aberrant expression of miRs in hepatic tissue from subjects with liver disease and HCC , and provide exciting possibilities for the discovery of bio-markers for early diagnosis of viral-associated HCC .

For CHB, aberrant expression of multiple miRs has been reported to be associated with HCC development. MIR196A2 polymorphism was associated with susceptibility to HBV-related HCC in a male Chinese population . HBx expression may negatively interfere with DNA repair and tumour suppressors by altering expression of multiple miRs through upregulation of HBxAg-upregulated gene 11 . HBx- and URG11-induced upregulation of miR-148a has been shown to drive cell cycle progression and cell migration by suppressing phosphatase and tensin homologue, thus increasing AKT mTOR signalling . Altered miR-122a expression inhibits HBV replication, changes the cell cycle by affecting cyclin G1 expression and inhibits expression of p27 .

If I Have No Symptoms How Would I Know If I Have Hepatitis B

To confirm whether or not you have hepatitis B, you will need blood tests.

If you have at least one risk factor , you should ask your health care provider to be tested for hepatitis B. Also, you should be tested for hepatitis B if:

• you were born in a region where hepatitis B is more common, including Asia, Africa, southern and eastern Europe, the Pacific Islands, the Middle East, and the Arctic
• one or both of your parents immigrated from a region where hepatitis B is more common
• you live or travel to regions where hepatitis B is more common
• you have a family history of liver disease or liver cancer
• you have been in prison
• you are pregnant
• you have ever used injection drugs, even just once
• you have unexplained abnormal liver enzymes or if
• you receive medicines that suppress the immune system.

Hepatitis B Management After Transarterial Chemoembolization In Patients With Inoperable Hepatocellular Carcinoma

Transarterial chemoembolization promotes reactivation of hepatitis B in patients with detectable anti-HBc antibodies and undetectable HBsAg, so they need antiviral treatment, regardless of treatment received for cirrhosis, even if HBV RNA was no longer detectable preoperatively .

Xu et al. demonstrated increased duration to HCC progression in patients treated with lamivudine after HCC surgery, as compared to subjects not receiving nucleoside analogues after cancer treatment , as well as better 1-year , 2-year and 5-year survival . Lamivudine treatment and low AFP levels were found to significantly affect patient survival .

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What Increases Your Risk

People who have certain behaviours or certain jobs are at high risk for becoming infected with hepatitis B.

Job risk factors include:

• Handling blood or body fluids as a routine part of your job. This includes health care workers, such as doctors, dentists, nurses, and blood and lab technicians, and students in these jobs. It also includes morticians and embalmers.
• Being an employee or resident of an institution for people who have developmental disabilities.
• Being an employee or inmate of a prison.

Lifestyle risk factors include:

• Being born in, or travelling to, parts of the world where hepatitis B is common or where a large number of people have been infected for a long time. Such areas include Southeast and Central Asia, the islands of the South Pacific, the Amazon River basin, the Middle East, Africa, Eastern Europe, and China.
• Being a man who has sex with men.
• Being sexually active. This includes having unprotected sex with someone who is infected with the virus or whose sexual history is unknown to you.
• Having more than one sex partner.
• Living with someone who has a chronic hepatitis B infection.
• Getting body piercings or tattoos from someone who doesn’t sterilize his or her equipment.
• Sharing needles or other equipment to inject illegal drugs.

Other factors include:

• Hepatitis B and C: Should I Be Tested?

Are There Treatments For Hepatocellular Carcinoma

The treatment of HCC depends on the extent of tumour spread , the speed of tumour growth, and the overall health condition of the person. Staging is often done by imaging of the body, including CT scans, MRIs, and bone scans. Small primary cancers of the liver are curable. Cure rates generally decrease as the tumour size increases. Treatment of liver cancer may involve surgery, radiation therapy and chemotherapy or liver transplantation.

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How Is It Transmitted

Hepatitis B is highly infectious, and is spread from one person to another through exposure to infected blood and body fluids . It can be spread through:

• blood transfusions or organ transplantation in countries where blood or blood products have not been properly screened for hepatitis B and other viruses transmitted through blood
• unprotected sex with an infected person
• sharing needles or equipment for injecting drugs
• unsterilized medical/dental equipment and shared/contaminated materials or equipment used for tattooing, body piercing or acupuncture
• sharing toothbrushes or razors
• childbirth
• household contact between family members

Hepatitis B And Liver Cancer

Tomorrow, February 4th, marks World Cancer Day! This day harnesses the international community to raise awareness, improving education and catalysing personal, collective and government action, were working together to reimagine a world where millions of preventable cancer deaths are saved and access to life-saving cancer treatment and care is equal for all no matter who you are or where you live.

Hepatitis B and Liver Cancer

Cancer is a disease in which normal cells change and grow uncontrollably, that can form a lump called a tumor or mass. A tumor can be benign or malignant . The name of the cancer depends on the part of the body where the cancer first started. The term primary liver cancer refers to hepatocellular carcinoma , the most common type of liver cancer, which starts in liver cells called hepatocytes.

In the United States, primary liver cancer has become the fastest growing cancer in terms of incidence , in both men and women. From 2012-2016, the incidence of liver cancer increased by 2.5%, the largest increase of any cancer during the time period. In 2018, an estimated 42,220 new cases of liver cancer were diagnosed and an estimated 30,200 people died.

Prevention

For more information about liver cancer please visit our Liver Cancer Connect page.

References

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If I Am Infected How Can I Prevent Passing On The Virus To Others

If you have a current hepatitis B infection you should:

• Avoid having sex with anyone until they have been fully immunised and checked with a blood test to see that the immunisation has worked.
• Not share any injecting equipment such as needles, syringes, etc.
• Not donate blood or semen or carry a donor card.
• Not share razors, toothbrushes, etc, that may be contaminated with blood.
• Cover any cuts or wounds with a dressing.
• Make sure that, if any of your blood spills on to the floor or other surfaces following an accident, it is cleaned away with bleach.

Hepatitis C And Cancer: What To Know

Hepatitis C is one of the leading causes of liver cancer. Its also linked to non-Hodgkins lymphoma, cancer in the bile ducts, and possibly pancreatic and head and neck cancers. And if you already have any other type of cancer, it can cause additional complications. Thats why MD Anderson tests all new patients for hepatitis C.

The good news is that if its found early and treated, hepatitis C can be cured, reducing your risk for cancer and other complications. Thats why hepatitis C screening and treatment is so important.

Unfortunately, an estimated 3.2 million people in the U.S. living with a chronic hepatitis C infection and dont know theyre infected. In many cases, thats because chronic hepatitis C doesnt any symptoms until the liver shows signs of damage.

We talked to Harrys Torres, M.D., associate professor of Infection Diseases and founding director of the hepatitis C clinic at MD Anderson, about what you should know about hepatitis C. Heres what he had to say.

Whats the link between hepatitis C and cancer?

There are two types of hepatitis C:

• acute or short-term hepatitis C, which goes away on its own in less than six months
• chronic hepatitis C, which requires treatment

The reason chronic hepatitis C causes multiple types of cancer is complex and not fully understood. The good news is that in most cases, hepatitis C infection can be cured with medication, and treatment can prevent many associated cancers.

Who is at risk for hepatitis C?

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Data Extraction And Quality Assessment

Two authors independently screened and extracted data from the included studies. Screening was carried out in two steps. First, based on title and abstracts only, and then second, based on a full-text review of potentially eligible studies. Data extraction was performed according to extraction forms. Discrepancies between researchers in screening and data extracting were discussed and resolved with a senior author. The meta-analysis used data from included studies incorporated into fully adjusted models. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of the included studies .

The Role Of Hepatitis B Virus In Promoting Hepatocarcinogenesis

CHB-associated inflammation and liver damage foster the accumulation of genetic and epigenetic defects that lead to the onset of HCC. However, a direct and specific contribution of the virus is supported by clinical observations and experimental data. Thus, HCC develops in 1020% of HBV-infected individuals who lack any sign of cirrhosis. HCC can even develop in the absence of inflammation, which is in stark contrast with most other aetiologies associated with HCC . HBV has a number of features that are known to contribute to HCC development independently of inflammation . HBV genomes can integrate into the host genome and induce chromosomal alterations and insertional mutagenesis of cancer genes . High-throughput next-generation sequencing approaches identified some recurrent sites for integration in biopsies taken from HCC but at low incidence , myeloid/lymphoid or mixed-lineage leukemia 4 , cyclin E1 , neurotrophic tyrosine kinase receptor type 2 , interleukin-1 receptor-associated kinase-like 2 , mitogen-activated protein kinase 1 ) . In addition, viral promoter-driven human transcripts have been reported within or close to repetitive, non-coding sequences, such as LINEs or SINEs . Although, taken together, HBV integration is random and rarely leads to direct oncogene activation or inactivation of a common tumour suppressor , it is widely accepted that integration contributes to the genetic instability of the hepatocyte and marks clonally growing hepatocytes.

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C History Part : Competing Diagnoses: Other Causes Of Hepatitis:

Acute hepatitis

• Viral hepatitis: acute hepatitis A , acute hepatitis C , human immunodeficiency virus , cytomegalovirus , Epstein-Barr virus , Herpes simplex virus

• Drugs/Toxins: Alcohol, acetaminophen is the most common drug and a history of ingestion often present, amatoxins , cocaine

• Autoimmune: Autoimmune hepatitis

• Hereditary: Acute Wilsons disease

• Vascular: Budd-Chiari syndrome, congestive heart failure, hypotension/shock liver

Chronic hepatitis

• Viral hepatitis: chronic hepatitis C

• Drugs/toxins:

• Autoimmune: autoimmune hepatitis, primary biliary cholangitis , primary sclerosing cholangitis

• Hereditary: hemochromatosis, Wilsons disease, alpha-1 antitrypsin deficiency

Selective Internal Radiation Therapy

Also known as radioembolisation, this treatment targets liver tumours directly with high doses of internal radiation in tiny beads. It is used for both primary and secondary cancers in the liver when the tumours can’t be removed with surgery. It is not available in all areas, so talk to your doctor about availability and costs involved.

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B Positive Program For People Diagnosed With Chronic Hepatitis B

From 2008 to 2016, Cancer Council NSW funded the B Positive program, to increase awareness of the link between chronic hepatitis B infection and liver cancer. While the B Positive program is now closed, enrolled participants will continue to receive high quality care from our General Practitioner collaborators.

Indirect Effects Of Hepatitis C Virus

HCV infection is sensed by host pathogen-associated molecular pattern receptors that induce interferons and local inflammatory responses. HCV has evolved diverse mechanisms to antagonize these early host immune responses . The majority of infected individuals develop chronic immune-mediated inflammation, accompanied by repeated cycles of hepatocyte destruction and regeneration that are considered to be key drivers in liver cancer. Activated inflammatory cells release ROS and induce lipid peroxidation, which promotes a pro-carcinogeneic environment . Indeed, the observation that most HCV-associated HCC develops in a background of advanced fibrosis and cirrhosis supports a role for host inflammatory responses in this cancer.

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Blood Tests To Check For Liver Damage

Blood tests may be done to help find out if your liver has been damaged. They include:

• Bilirubin, albumin, and prothrombin time. These help show how well your liver is working. Cholesterol testing also may be done.
• Alanine aminotransferase , aspartate aminotransferase , alkaline phosphatase, and lactic dehydrogenase . These show whether your liver is damaged or inflamed.

What Are The Risk Factors Associated With Liver Cancer

In the absence of chronic liver disease, liver cancer is rare. However, in people with an underlying liver disease, liver cancer may be quite common. The exact cause of liver cancer is not known, but scientists have identified many risk factors that can make someone more likely to develop liver cancer:

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Should People With Cancer Be Tested For Hepatitis B

The American Society of Clinical Oncology published an updated provisional clinical opinion on screening and management of hepatitis B virus for people with cancer on July 27, 2020. Provisional clinical opinions are recommendations for care based on the newest information in cancer care. Hepatitis B is a virus that infects the liver and if its not identified before cancer treatment starts, it may grow unchecked and possibly cause complications.

In this podcast, Andrew Artz, MD, MS, and Jessica Hwang, MD, MPH, discuss what people with cancer and their loved ones should know about hepatitis B virus, including what it is, who should be screened for it, and how it can impact people with cancer. Dr. Artz and Dr. Hwang were co-chairs for the development of this provisional clinical opinion.

• What is a provisional clinical opinion, and how does it influence cancer care?

• What is hepatitis B virus, and how is it connected to cancer?

• Who should be screened for hepatitis B virus, and when should people be screened?

• How are people tested for hepatitis B virus?

• What are some of the problems that hepatitis B can cause during cancer treatment?

• Hepatitis B virus can reappear or flare up in people with a chronic hepatitis B infection or who previously had an infection. If this happens, it is called reactivation. What does ASCO recommend to reduce the risk of a hepatitis B reactivation?

Cancer.Net podcasts are edited for length and content.

Can Primary Liver Cancer Be Prevented

Prevention is the best defence against primary liver cancer. Worldwide, the most common risk factors for primary liver cancer are chronic hepatitis B and C infections. Therefore, the prevention of these forms of liver disease is essential. The Canadian Liver Foundation recommends that all children, as well as adults at high risk of being exposed to the virus, should be vaccinated against hepatitis B.

Since there is no vaccine against hepatitis C, it is crucial to prevent the spread of this disease and to identify and assess all those who are already infected with the hepatitis C virus for treatment. The Canadian Liver Foundation recommends that all people with risk factors and adults born between 1945 and 1975 should get tested for hepatitis C.

Alcohol intake should be limited to no more than one to two standard drinks per day. Drinking alcohol every day, as well as binge drinking, can be harmful to your liver. If you already have a liver disease, the safest amount of alcohol is no alcohol at all.

As mentioned earlier, non-alcoholic fatty liver disease and its most severe form, non-alcoholic steatohepatitis can lead to liver cancer. It is important to maintain a healthy body weight, eat a well-balanced diet, and introduce exercise into your daily routine.

What does the future hold?

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How Is It Treated

In most cases, hepatitis B goes away on its own. You can relieve your symptoms at home by resting, eating healthy foods, drinking plenty of water, and avoiding alcohol and drugs. Also, find out from your doctor what medicines and herbal products to avoid, because some can make liver damage caused by hepatitis B worse.

Treatment for chronic hepatitis B depends on whether your infection is getting worse and whether you have liver damage. Most people with chronic hepatitis B can live active, full lives by taking good care of themselves and getting regular checkups. There are medicines for chronic hepatitis B, but they may not be right for everyone. Work with your doctor to decide if medicine is right for you.

Sometimes, chronic hepatitis B can lead to severe liver damage. If this happens, you may need a liver transplant.

What You Can Do To Help Manage The Symptoms Of Liver Cancer

Symptom management is an important aspect of coping with liver cancer. When symptoms are properly addressed and managed, it can significantly strengthen the capability of your loved one and their overall quality of life. Below are common symptoms experienced by those with liver cancer and suggestions that caregivers can use to help manage these symptoms. Always consult with your healthcare provider before trying any of the following suggestions:

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